Representations of cancer and end-of-life experiences are often sombre, if not gloomy, and the idea that you can laugh about cancer or death seems alien to many. Yet, in the context of the Metaphor in End-of-Life Care (MELC) project analysing descriptions (in English) of people’s experiences in the UK, we discovered many humorous uses of metaphor online. People with (sometimes incurable) cancer actively use humour to build a community, to support each other and to cope with their illness.

On one online cancer forum, we identified a thread explicitly dedicated to those with a ‘warped’ sense of humour. On this thread, 68 participants, mostly patients, regularly joked about their illness experiences and made fun of their cancer. For example, one frequent strategy was to personify and mock the illness itself:

It’s just one of the evil Mr Crab’s funny little jokes that we now have to spend our lives thinking not just “What shall I have for tea?” but “What shall I have for this random nameless meal – that I am having at an odd time because I couldn’t face food till now – that won’t kill me?” I am pretty sure that my own evil Mr Crab has taken control of my stomach-to-brain signals. He gets hungry in the night and demands steak and chips. I don’t eat meat!! Bastard.

In this kind of example, people with cancer refer to not being in control of their circumstances in some way and joking seems to be a way of rebalancing things, of empowering themselves. By making fun of a personified cancer, they are able to assert a certain amount of virtual power in the face of a potentially life-threatening and uncontrollable illness.

‘In-group’ humour (what only those regularly following the thread would get) is another strategy. A recurring example involves a metaphorical ‘rescue mission’, used when contributors discuss upcoming medical tests. Check-ups always induce anxiety, and everyone hopes that no evidence of cancer will be found. If, however, the results mean that contributors risk having to stay in hospital for further testing (which they can tell the group from their hospital bed via the online forum), the group offers to send a ‘rescue team’:

It’s got to be good results [Contributor A] or they’ve made a mistake. Don’t forget we have a formidable fighting force in our rescue team which now has two successful missions under their belts. Tell them if they get it wrong we will all travel in [Contributor B’s] bin to put it right. We’ve all got everything crossed.

This example refers to earlier posts and it takes some investigation to get the joke. The mention of B’s bin, for instance, refers to a story that B told much earlier, over several posts: at one point, she notices a strange noise coming from her garage, eventually identifying an old fire alarm with a flat battery as the source. She decides to put it in her garbage bin because the bin men are due that day. The bin men, however, do not turn up. This spurs a humorous, absurdist, fantasy scenario in which passing neighbours call the ‘bomb squad’ for fear of what might be in the bin. While B’s story unfolds, Contributor C describes having to stay in hospital longer than expected “still imprisoned” by “warders”. In response, Contributor D asks whether they could use B’s bin with the smoke alarm as a distraction to get C “evacuated”. The example above transfers this entire scenario with all its laughter-inducing interconnections to the situation of A

This kind of humour is co-created and accessible only to those within the group, so it helps create a sense of community and solidarity. Crucially, this has the potential to reduce feelings of loneliness and isolation – feelings all too common amongst people with cancer, and particularly incurable cancer.

Overall, joking and laughing about cancer seems to help patients turn serious, threatening and unpredictable experiences into objects of non-serious play, reducing their psychological impact. The humour strategies are not without risks: newer contributors could feel left out; jokes about cancer may cause offence. Nevertheless, it seems that, for the 68 individuals we were able to ‘observe’ online, these humour strategies are helpful, and perhaps even essential.

More about the authors…Dr Zsófia Demjén, Lecturer in English Language/Applied Linguistics, The Open University.Sheila Payne, Emeritus Professor, International Observatory on End of Life Care,Division of Health Research, Lancaster University.Professor Elena Semino, Department of Linguistics and English Language, Lancaster University.